HomeMy WebLinkAbout08-27-07 (3)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
REV.1500 EX + (6-00)
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Gouse, Arlene E.
DATE OF DEATH (MM-DD-YEAR)
FILE NUMBER
~ 07 00060
CQLLNTY CQD~ YEAR_ . NUMBER
SOCIAL SECURITY NUMBER
I-
Z
W
C
W
U
w
c
159-24-9482
01-12-2007
: DATE OF BIRTH (MM-DD-YEAR)
I 12-09-1928
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
x 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death prior to 12-13-82)
UJ
....
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0"':0:
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",00
0"'""
II.Cll
II.
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4. Limited Estate
4a. Fulure Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
c I 1 O. ~n~-~~I (date of death between
5. Federal Estate Tax Return Required
x 6. Decedent Died Testate (Attach
copy of Will)
I ,9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A) (Attach Sch 0)
....
z
UJ
~ Jan M. Wiley
2 FIRM NAME (If applicable)
~ Wiley, Lenox, Colgan, & Marzzacco, P.C.
'"
8 TELEPHONE NUMBER
717-432-9666
3. Closely Held Corporation, Partnership or Sole-Proprietorship
130 W. Church St
Dillsburg, PA 17019
(1 ) 45,605.70 OFFICIAL I)SE ONL Y
.~ )
"
(2) None
(3) None , :
(4) None .-...J
(5) 105,569.65
(6) None
(7) None
(8) 151,175.35
(9) 21,629.91
(10) 6,393.40
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
z 6. Jointly Owned Property (Schedule F)
~ r .1 Separate Billing Requested
:5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
~ (Schedule G or L) Separate Billing Requested
~ 8. Total Gross Assets (total Lines 1-7)
frl 9. Funeral Expenses & Administrative Costs (Schedule H)
0::
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
28,023.31
123,152.04
0.00
12. Net Value of Estate (Line 8 minus Line 11)
(12)
(14)
123,152.04
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z
0 (16)
~ 16.Amount of Line 14 taxable at lineal rate 123,152.04 x .045
<(
I-
::::l
a- 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
::E
0
u 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
><
~ 19. Tax Due
(19)
0.00
5,541.84
0.00
0.00
5,541.84
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT,
>>SE SURE TO ANSWER ALL QUESTIONS ON REVERSE SlOE AND RECi-iCKMATH << ~~----~~---_.._------ -
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
c.m
Decedent's Complete Address:
STREET ADDRESS
1 Longsdorf Way, Carlisle, PA
Cumberland Crossings
CITY Carlisle
STATE P A
ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
5,541.84
4,916.25
258.75
Total Credits (A + 8 + C)
(2)
5,175.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 366.84
(5A)
(58) 366.84
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................. ......................................... x
b. retain the right to designate who shall use the property transferred or its income;.................. x
c. retain a reversionary interest; or.............................................................................. ............... ................... IX,
d. receive the promise for life of either payments, benefits or care?....... ...................................................... i xj
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.. ...................... ................. .................................. ............ ............................... !X I
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............................. ............................ ................ ............... : x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury. I declare that I have examined this return. Including accompanying schedules and statements, and to the best of my knowledge and belief. It IS true. correct and
complete. Declaration of preparerother than the personal representative isbased on all information of which preparer has any knowledge
SiGNATidRE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
,;!1~CC~jf}1LILtt~, /J-"
~~tuRE OF tER,sON RESPONSIBLE FOR f'-L1NG R - RN .
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~n':~:~~6iH'~'~"'"
IX
DATE
805 Yellow Hill Road
Biglerville, PA 17307
g2 ?J--O?
ADDRESS
DATE
ADDRESS
?:/?--3/ () f
I ;ATE
130 W. Church St
Dillsburg, PA 17019
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)l.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)], The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. S9116 (a) (1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.
99116 1.2) [72 P,S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)]. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
LAST WILL AND TESTAMENT
OF
ARLENE E. GOUSE
I, ARLENE E. GOUSE, currently a resident of and domiciled in Carroll Township, York
County, Pennsylvania, do hereby make, publish and declare this to be my Last Will and
Testament, hereby revoking all Wills and Codicils at any time heretofore made by me.
ITEM I: Personal Effects. I give and bequeath all of my tangible personal
property, together with all policies of insurance thereon, to my daughter, LINDA S.
MCCULLOUGH. If LINDA S. MCCULLOUGH predeceases me leaving issue that survive me,
I give and bequeath all of my tangible personal property to her issue, per stirpes.
ITEM II: Specific Bequest. Ifmy husband, EARL C. GOUSE, survives me by
one hundred seventy (170) days, I give, devise and bequeath to my husband cash, securities or
other property of my estate having a value equal to the amount, if any, that my husband would be
entitled to receive if he exercised his elective share rights as set forth in section 2201 et seq. of
the Pennsylvania Probate, Estates and Fiduciaries Code (the "PEF Code"); provided, however,
that this bequest shall be reduced to the extent my husband has waived the right to elect under
PEF Code section 2207 or forfeited the right to elect under PEF Code section 2208. In
computing the amount of this bequest, it shall be assumed that my husband has elected under
PEF Code section 2204( c) to retain all beneficial interests in property that he would otherwise be
required to disclaim ifhe exercised his elective share rights. Provided my husband survives me
for one hundred seventy (170) days and he has not waived or forfeited his elective share rights, it
is my intention, that as a result of my death, he receive property having a value equal to (but not
more than) that which he would receive ifhe were to exercise his elective share rights.
My Executor shall have the sole discretion to select the assets which shall constitute this
bequest. If my husband does not survive me by one hundred seventy (170) days, or in the event
my husband (or his legal representative) disclaims any portion of this bequest, this bequest, or
the disclaimed portion thereof, shall be distributed as part of my residuary estate.
This bequest shall be distributed, in trust, to my hereinafter-named Trustee to be held,
administered and distributed as follows:
(a) My Trustee may pay to or apply for the benefit of my husband during his lifetime
such sums from the net income or principal of this trust as in its discretion shall be necessary or
desirable from time to time for his medical care, support, and maintenance in reasonable
comfort, or for any other reason my Trustee deems appropriate. Any net income not paid shall
be accumulated and added to principal. Upon the death of my husband prior to complete
-1-
distribution of this trust, the then remaining principal and accrued income shall be distributed
pursuant to Item III of this Will as ifI had then died.
(b) Whenever my Trustee makes a distribution, it may be paid out in such of the
following ways as my Trustee deems best: (1) directly to my husband; (2) to my husband's
legally appointed guardian or attorney-in-fact; (3) to some relative or friend for the care and
support of my husband; (4) orby my Trustee using such amounts directly for my husband's care
and support. My Trustee shall have no further responsibility for funds so paid.
ITEM III: Residuary Bequest. I give, devise and bequeath all the rest, residue
and remainder of my estate to my daughter, LINDA S. MCCULLOUGH. If LINDA S.
MCCULLOUGH predeceases me leaving issue who survive me, I give, devise and bequeath aU
the rest, residue and remainder of my estate to her issue, per stirpes.
ITEM IV: Executor. I appoint my daughter, LINDA S. MCCULLOUGH, as
Executrix ofthis Will.
ITEM V: Trustee. I appoint my daughter, LINDA S. MCCULLOUGH, as
Trustee of the trusts created hereunder.
(a) The then acting Trustee shall have the power to appoint at any time and from time
to time any person or bank or trust company to act as successor Trustee in the event that the
initial Trustees shall be unwilling or unable to serve or continue to serve as a Trustee.
(b) Whenever a bank or trust company is serving as Trustee hereunder, the
beneficiary of any such trust (or such beneficiary's authorized agent or legal representative) shall
have the power to remove such Trustee and replace the same with some other bank or trust
company to act as successor Trustee. The successor must be a bank or trust company that is not
related or subordinate to any trust beneficiary within the meaning of Section 6n( c) of the
Internal Revenue Code. The removal shall not be effective until a successor has accepted its
appointment.
(c) Any successor Trustee shall have the same powers, duties and authorities as
though named hereunder as an original Trustee. Any successor Trustee shall be exempt from
any liability in any way related to the prior actions or omissions of the Trustees hereunder, and
each shall be entitled to accept as conclusive any accounting and statement of assets furnished by
any predecessor Trustee.
(d) Any removal, resignation, appointment or acceptance of trusteeship shall be made
by written instrument duly signed, acknowledged before a notary public and filed with the
records of the Trust. Any Trustee may resign at any time without court approval; provided,
however, if the resigning Trustee was serving as sole Trustee, such resignation shall not be
effective until a successor has accepted an appointment as Trustee.
-2-
-
(e) Notwithstanding any provision herein to the contrary, no Trustee may participate
in the exercise of any discretion to distribute principal to himself or herself other than for his or
her health, education, support or maintenance, nor may any Trustee participate in the exercise of
any discretion to distribute or expend principal or income to satisfy any of the trustee's personal
legal obligations for support or other purposes.
ITEM VI: Fiduciary Powers. All fiduciaries (which term whenever used herein
shall include my Executors and Trustee and their successors) serving hereunder shall do so
without bond or other security in any jurisdiction. In addition to powers given them by law, all
fiduciaries acting under this, my Last Will and Testament, shall have the following powers,
applicable to all property held by them, effective without court order and until actual
distribution:
(a) To retain any or all of the assets of my estate or trust, real or personal, without
regard to any principle of diversification or risk;
(b) To sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges or leases, for such prices
and upon such terms or conditions as they deem proper;
(c) To invest in all forms of property (including stock, common trust funds and
mortgage investment funds whether maintained by my corporate fiduciary, if any, or others)
without restriction to investments authorized for Pennsylvania fiduciaries;
(d) To make distribution in cash or in kind, or partly in cash and partly in kind, and in
such manner as they may determine, and at valuations finally to be fixed by them;
(e) To allocate receipts and expenses to principal or income or partly to each as they
from time to time deem proper in their discretion;
(f) To engage in litigation and compromise, arbitrate or abandon any claim;
(g) To borrow money from any person or institution, and to mortgage or pledge any
or all real or personal property as they in their discretion shall choose, without regard for the
dispositive provisions of this instrument;
(h) To continue and operate any business owned by me at my death for such time as
my fiduciary shall deem advisable;
(i) Power in my executors to disclaim on my behalf any property or interest in
property which would otherwise have passed to me by any means prior to my death.
G) Power in my Trustee to combine assets of two or more trusts (including trusts
created by third parties) if the provisions of each are substantially identical, and to administer
them as a single trust, if my Trustee reasonably deems it appropriate and the combination is
consistent with my intent, and facilitates the trust's administration without defeating or impairing
the interests of the beneficiaries.
(k) In general, to exercise all of the powers in the management of my estate which
any individual could exercise in the management of similar property owned in their own right,
upon such terms and conditions as my fiduciaries may see best, and to execute and deliver any
and all instruments and to do all acts which my fiduciaries may deem proper or necessary to
-3-
carry out the purposes of this my Will, without being limited in any way by the specific grants of
power made, and without necessity of a court order.
ITEM VII: Spendthrift Clause. Except as otherwise provided herein, all
payments of principal and income payable, or to become payable, to the beneficiary of any trust
created hereunder shall not be subject to anticipation, assignment, pledge, sale or transfer in any
manner, nor shall any said beneficiary have the power to anticipate or encumber such interest,
nor shall such interest, while in the possession of my Executor or Trustee, be liable for, or
subject to, the debts, contracts, obligations, liabilities or torts of the beneficiary.
ITEM VIII: Beneficiaries Under 21. If any share of my estate becomes
distributable to a beneficiary who has not attained the age of twenty-one (21) years, then the
same shall be paid to a custodiqn for the beneficiary under the Pennsylvania Uniform Transfers
to Minors Act. The custodian shall be selected by my Executor, and may be my Executor or the
minor's parent. The receipt of the custodian shall be a full discharge of my Executor.
IN WITNESS WHEREOF, I have hereunto set my han~L.and affixed my seal to this, my
Last Will and Testament, consisting of five (5) pages, this /OTldayof
reB12.u47 ,2003.
t('
.J
-~ ~ ~L<2--~ (SEAL)
ARLENE E. GOUSE
SIGNED, SEALED, PUBLISHED AND DECLARED by the above Testatrix as and for her
LAST WILL, in the presence of us who thereupon at her request, in her presence and in the
presence of each other have hereunto subscribed our names as witnesses:
C\ ~ -://[-<-.-Z
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Address /
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Address
Name
-4-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
YoR.K
)
) SS:
)
I, ARLENE E. GOUSE, the Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will; and that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
Sworn to or af(\tilled and acknowledged before me by ARLENE E. GOUSE, the
Testatrix, this J O.fday of r@ AR 1/ It- R j ,2003.
Notary~ ~~
I-.:~---,..,. ~ ~~,~ :;-- l - --.
--'=---..-",. ''-~-
II (;S\L
H'Ff2:F ,,:
~ a/(LA~ ~ Jt!) ~<~
ARLENE- E. GOUSE .
~,~~<~~'~~:!:~~~i;~"~:~~ii:J
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:'./JTi;-;'::;-'~_: :':}; .;:: '. ~
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COUNTY OF
'jOKK
)
) SS:
COMMONWEALTH OF PENNSYLVANIA
We, ., <.I I,-,..J L. /U.-e ""I and !--.o ,- s. Z -e ,-~ /--e .- , witnesses,
whose names are sign to the attached or foregoing instrument, being uly qualIfied accordmg to
law, do depose and say that we were present and saw the Testatrix sign and execute the instrument
as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for
the purposes therein expressed; that each subscribing witness in the hearing and sight ofthe Testatrix
signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18
or more years of age, of sound mind and under no constraint or undue influence.
and
Sworn to or affirmed and subscribed to before me by
~ ;~ 2a/cyJe/2 , witnesses, this
FtZ- 6Rv 41'2Y ,2003.
/
CltR-01..l/l) L.I1I<?AL
.It} 11\ d yof
G~ -;/~<-
"/
Witness
/)
~
//f-H---
Witness
~€ JM~~
Notary Publi
NOTARIAL SEAL
OHERI!': E. DRAWBAUGH, NOTARY PUBLIC
l)ltLSBURG BOROUGH. COUNTY OF YORK
MY COMMISSION EXPIRES .~PRIL 13. 2006
-6-
Rev-1502 EX+ (6-98)
.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gouse, Arlene E.
FILE NUMBER
21-07 -00060
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seHer, neither being compeHed to buy or sell, both having reasonable knowiedge of the relevant facts
Real property which Is jointly-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Properties situate in Tyrone Township, Perry County, PA:
45.605.70
TOTAL (Also enter on Line 1, Recapitulation)
45.605.70
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
THE WILEY
GROlJP
.\TrOR~EYS AT lAW
UO \I. ("IIlR( H STREET
SL'ITF HX)
D1I.I.SIl1IR(;.I'A 17019
Parcel ID:
270,178,02-045.000 &
270,1 78.02-042.000
INDENTURE
THIS INDENTURE, made theZ3 '~~ay of ~0 1 '-' "7-i
2007, BY AND BETWEEN,
LINDA S. McCULLOUGH, Executrix, under the Last Will and Testament of ARLENE
E. GOUSE, late of 1 Longsdorf Way, Cumberland Crossings, Carlisle, Pennsylvania, herein
referred to as GRANTOR of the One Part,
AND
LINDA S. McCULLOUGH and KENNETH H. McCULLOUGH, JR., husband and wife,
of 805 Yellow Hill Road, Biglerville, Pennsylvania, herein referred to as GRANTEES, of the
Second Part.
WHEREAS, ARLENE E. GOUSE, departed this life on January 12,2007, having first
made her Last Will and Testament in writing; and
WHEREAS, LINDA S. McCULLOUGH, was appointed and constituted as Executrix
of the Estate of said ARLENE E. GOUSE by Item # IV of said Will; and
WHEREAS, LINDA S. McCULLOUGH, pursuant to the power granted to her, is
desirous of conveying said piece or parcel of real estate described herein, owned by the Estate
of ARLENE E. GOUSE.
Page 1 of 5
HIE WTI"EY
GROUP
.\TlOR"EYS AT LAW
UO W. CHLRUI STREET
SurrE !lX)
DILLSBI 'R(;. PA 17019
WITNESSETH
That the said GRANTOR for and in consideration ofthe sum of ONE DOLLAR ($1.00)
lawful money of the United States of America, unto her well and truly paid by the GRANTEES
at or before the sealing and delivery hereof, the receipt whereof is hereby acknowledged, has
granted, bargained, and sold, aliened, enfeoffed, released and confirmed and by these presents
does grant, bargain and sell, alien, enfeoff, release and confirm unto GRANTEES, their heirs,
successors and assigns:
ALL THOSE CERTAIN two (2) tracts ofland situate in the Township of Tyrone, County of
Perry and Commonwealth of Pennsylvania, more fully bounded and described as follows, to wit:
TRACT No.1:
BEGINNIN G at a point in the center of the Kennedy's Valley Road; thence North fifty- four (54)
degrees East, one hundred eighty (180) feet to a point in the center of Kennedy's Valley Road;
thence North sixty-one and one half (61 Yz) degrees East, twenty (20) feet to a point in the center
of the Kennedy's Valley Road; thence South thirty-four (34) degrees East, two hundred seventy-
six seventy-five hundredths (276.75) feet along the lands now or formerly of Malcolm C. Crull
to an iron pin; thence South fifty-six (56) degrees West, eighty (80) feet along the lands of the
same to a point in the center of the Macabes Run; thence South eighty (80) degrees West, one
hundred thirty-two (132) feet along the center of the Macabes Run to a point in the center of the
same; thence North thirty-four (34) degrees West, two hundred seventeen (217) feet along the
lands now or formerly of Gerald T. Walsh to the point ofBEGINl'Ht'-JG.
CONTAINING 188 perches more or less.
TRACT No.2:
BEGINNING at a point in the center of the Macabes Run; thence North fifty (50) degrees East,
one hundred (100) feet to a point in said Run, along lands now or formerly of Joseph W. Nelson
and Mary H. Nelson, his wife; thence North forty-five (45) degrees East, one hundred (100) feet
along the lands now or formerly of Carl W. Nelson, to a point in the center of the said Run;
thence South thirty-four (34) degrees East, two hundred five (205) feet, along the lands now or
Page 2 of 5
THE WILEY
GROUP
\.TIOI<NEYS AI' LAW
LJO IV. ( .BURCIl STREET
surn: HXI
IlILL'iBlIR(;. PA 17019
formerly of Malcolm C. Crull to an iron pin; thence South forty-nine (49) degrees West, two
hundred (200) feet, along the lands now or formerly of Malcolm C. Crull to an iron pin; thence
North thirty-four (34) degrees West, two hundred (200) feet along the lands now or formerly of
Clarence Crull to the point of BEGINNING.
CONT AINING .9 acres, more or less.
BEING the same premises which Earl C. Gouse, by his attorney-in-fact, Arlene E. Gouse, under
Power of Attorney dated February 11,2003, and Arlene E. Gouse, husband and wife, by their
deed dated February 14, 2003 and recorded in the Office of the Recorder of Deeds in and for
Perry County, Pennsylvania, on February 20, 2003, in instrument number 200301726, granted
and conveyed unto Arlene E. Gouse, who died on January 12,2007, and by her Last Will and
Testament, duly probated in the Office of the Register of Wills in and for Cumberland County,
Pennsylvania on January 17, 2007, did nominate, constitute and appoint LINDA S.
McCULLOUGH, EXECUTRIX, GRANTOR HEREIN.
THIS IS A CONVEYANCE TO CONFIRM THE DISTRIBUTION OF THE EST A TE OF
ARLENE E. GOUSE TO HER DAUGHTER, LINDA S. McCULLOUGH, AND IS
THEREFORE EXEMPT FROM REALTY TRANSFER TAXES.
UNDER AND SUBJECT, NEVERTHELESS, to easements, conditions and restrictions of
prior record pertaining to said premises.
TO HAVE AND TO HOLD the said piece or parcel of land above described with
buildings and improvements thereon erected, hereditaments and premises hereby granted and
released, or mentioned and intended so to be, with the appurtenances, unto the said GRANTEES
their heirs, successors and assigns, to and for the only proper use and behoof of the said
GRANTEES, their heirs, successors and assigns forever.
AND the said LINDA S. McCULLOUGH, Executrix, of the Estate of ARLENE E.
GOUSE, for herself and her successors, does hereby by these presents covenant, promise and
Page 3 of 5
"
THE WILEY
GROUP
UTOR:\'EYS AT L.m
130 W. CIIlRCH STREEI
SlJm:J(~1
IlII.LSBlR(;. m 17019
agree to, and with the said GRANTEES, their heirs, successors and assigns, that she the said
GRANTOR has not done, committed or knowingly or willingly suffered to be done, or
committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part
thereof, is, are, shall or may be impeached, charged or encumbered, in title, charge, estate or
otherwise howsoever.
IT WITNESS WHEREOF, the said LINDA S, McCULLOU GH, in her fiduciary capacity
as aforesaid and in her own right has caused this Indenture to be executed, attested to and dated
the day and year first above written.
'W;ITNfSS:
~" ,~ UY.,
(~
Page 4 of 5
THE WILEY
(;ROUP
.\ITOR'EYS Al I.A\I
un w. (.HLR( H STREET
St'ITE ilK)
DIl.LSBl f{(;. PA 1701~
COMMONWEAL TH OF PENNSYL VANIA
SS
COUNTY OF YORK
On this the~y of11, j 11'/J-;t 2007, before me, the undersigned officer, personally
appeared LINDA S. McCULL~xecutrix of the Estate of ARLENE E. GOUSE, known
to me (or satisfactorily proven), to be the person(s) whose name(s) is/are subscribed to the within
deed, and acknowledged that she executed the foregoing Indenture for the purposes therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal the day and year
first above written:
~1J:{J .JJ(U1fjJfj;;J
NOT ARY P HUC
MY COMMISSION EXPIRE~OMMOi.;iNE.4LTH.OF PENNSYLVANiA
Notanal Seal
S. Dawn Gladfelter, Notary Public
Dillsburg Boro, York County
My Commission Expires May 17, 2009
Member. Pennsylvania Association of Notaries
I hereby certifY that the precise address
of the Grantee (s) herein is:
//~--"')
L1r.dC\ :5'. ~<?C2...J \ \.Oql-l
B (j c"'- / ~ (I i:J W H: i , 2-~.
r:J. . /, ., \, 'I) . _ ., ~..,
bJI)'~V.~' "<',-{A IJ .jV{
_____ ~ L~7
TTORNEY FOR GRANtEE (S)
This document prepared by:
Jan M. Wiley, Esquire
130 W. Church St.
Dillsburg, P A 17019
717-432-9666
Page 5 of 5
RfV.18J fX 112.89)
~~
RECORDER'S USE ONLY
Slote Tax Paid
COMMONWEAltH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280603
HARRISBURG, PA 17128-0603
REALTY TRANSFER TAX
STATEMENT OF VALUE
Book Number
Page Number
DOle Recorded
See Reverse for Instructions
CompTErte each section and file in duplicate with Recorder of Deeds when (1) the full value/considerotion is not set forth in the deed, (2) when the dee<
is without consideration, or by gift, or (3) 0 tax exemption is claimed. A Statement of Value is not required if the transfer is wholly exempt from to)
based on: (1) family relationship or (2) public utility eosement. If more space is needed, attach additional sheet(s). _
j06l1}o
lb. Percentage of Interest Conveyed
100 '10
2. Check Appropriate Box Below for Exemption Claimed /7
~ Will or intestate succession ~rlefle- E. Q()(AS-e.-
~ (Nome of Decedent)
o Transfer to Industrial Development Agency.
o Transfer to agent or strow party. (Attach copy of agency/straw party agreement).
o Transfer between principal and agent. (Attach copy of agency/strow trust agreement). Tax paid prior deed S
o
~"0'7 - 000& 0
(Estate File Number)
Transfers to the Commonwealth, the United States, and Instrumentalities by gift, dedication, condemnation or in lieu of condemnation.
(Attach copy of resolution).
o Transfer from mortgagor to 0 holder of 0 mortgage in default. Mortgage Book Number
o Corrective deed (Attach copy of the prior deed).
o Statutory corporate consolidation, merger or division. (Allach copy of articles).
o Other (Please explain exemption claimed, if other than listed above.)
, Page Number
Under penalties of law, I declare that I have examined this Statement, including accompanying information, and to the best of my knowledge
and beli , it is true, correct and complete.
Signature f C"r~espondent or Responsible Party Date
<.:;.V-r vt--,.
u
6
CJ
C) 7
/ /
\...-r/
(SEE REVERSE)
12007/2008 REAL ESTATE TAX NOTICEI
=
West Perry School District
2606 Shermans Valley Road
Elliottsburg, PA 17024
BILL DATE: 07/01/07
BILL NO.: 003947
TAXES PAYABLE TO: West Perry School District
LOCATION: 1458 MCCABE ROAD
DEED REF: 02003-01726
PARCEL: 270,178.02-045.000
View property info at courthouseonline.com
Control = 00520885 Password = PRKONWCV
CONTROL NO: 27007-4
TAX MILLS: 14.4600
MUNICIPALITY: TYRONE TOWNSHIP
1",111",1"11,11",1",11.111.1,,11,,1,1,1,,11..,,1,1,1.,,II
GaUSE, ARLENE E 12901
805 YELLOW HILL RD T81 P1
BIGLERVILLE, PA 17307-9489
1 ST OF 3 EQUAL
INSTALLMENTS DUE
08/31/07*
$152.07
OR FULL PAYMENT
2% DISCOUNT BASE
07/1/07 TO 09/01/07 TO
08/31/07 10/31/07
1 0% PENALTY
11/01/07 TO
12/31/07
$501.83
$447.09
$456.21
~.sc;essme!lt L3nd: $12,920.00
Assessment Buiiding: $i6,630.00
Assessment Total: $31,550.00
IAYMENT
IUE DATES
INSTAllMENT
:>AYMENT
:)PTlON
~PPEAlS
IUESTIONS
REAL ESTATE TAX INSTRUCTIONS - PLEASE READ
PLEASE NOTE THAT WEST PERRY SCHOOL DISTRICT REAL ESTATE TAXES ARE NO LONGER BEING COLLECTED BY
YOUR LOCAL TAX COLLECTOR. PAYMENTS MAY BE MADE AT ANY BANK OF LANDISBURG BRANCH (Blain,
Landisburg or Shermansdale OR MAY BE MAILED TO THE BANK.
All Real Estate tax bills have been mailed to the property owner. If your bank or mortgage company pays
your real estate taxes, you must forward this bill to them.
ALL CHECKS SHOULD BE MADE PAYABLE TO WEST PERRY SCHOOL DISTRICT.
IN PERSON - Payments may be made at any Bank of Landisburg branch office (Blain, Landisburg or Shermansdale).
Oriqinal, payment stub attached below must accompany payment
BY MAIL - Mail the oriqinal, micr-encoded payment stub attached below with your check (made payable to West Perry
School District) in the enclosed envel~ Make sure address shows through envelope window. U.S. postmark will be
considered date paid. For receipt, enclose self-addressed, stamped envelope.
To pay 2% discount amount, make payment by 8/31/07.
To pay base amount, make payment between 911/07 and 10/31/07.
To pay penalty amount, make payment between 11/1/07 and 12/31/07.
After 12/31/07, unpaid bills will be turned over to Perry County Delinquent Collections.
All property owners have the opportunity to make installment payments in three (3) equal installments on the base
amount You may pay the first payment as indicated above by 8/31/07; additional coupons will be mailed to you for
payments due 10/31 and 12/31/07. Payment of the 1 st Installment Payment on or before the due date will indicate your
enrollment in the District's Installment Payment Plan. See insert for full terms and conditions of this payment oian
Questions regarding assessed value must be made to the Perry County AssessmentOffice (717) 582-2131 The school
district cannot make these changes. Appeal deadline is 9/1/07.
General questions regarding this tax bill, please call West Perry School
District at (717) 789-3934 ext. 5509 Monday-Friday 730AM to 330PM.
RETURN THIS STUB WITH PAYMENT I
TYRONE TOWNSHIP
270,17802-045000
1458 MCCABE ROAD
Please indicate:
ill FULL PAYMENT
::J 1ST INSTALLMENT
m07/2008 REAL ESTATE TAX
IIAIL TO:
BILL NO. 003947 2700
GOUSE, ARLENE E
805 YELLOW HILL RD
BIGLERVILLE, PA 17307-9489
o
W
N
E
R
West Perry School District
c/o The Bank of Landisburg
P.O. Box 185
Landisburg, PA 17040-0185
1",111",111""1"111",11,,,,,,111,,1.,1,1.1,,1,,1,1""III
FULL PAYMENT
1ST INSTALLMENT DUE DISCOUNT BASE PENALTY
8/31/07 07/01/07 - 08/31/07 09/01/07 -10/31/07 11/01/07 - 12/31/07
R ~ 1~
$152.07 $447.09 $456.21 $501.83
II- 2 70000 :1 9 ~ 711- I: 0 :1 ~ :1 ~ 2 ~ 2 :11:
Ob992:1:1I1-
855
12007/2008 REAL ESTATE TAX NOTICEI
West Perry School District
2606 Shermans Valley Road
Elliottsburg, PA 17024
BILL DATE: 07/01/07
BILL NO.: 003950
TAXES PAYABLE TO: West Perry School District
LOCATION: KENNEDY VALLEY ROAD"
DEED REF: 02003-01726
PARCEL: 270,178.02-042.000
View property info at courthouseonline.com
Control = 00520882 Password = PRSHT AGX
CONTROL NO: 27007-4
TAX MILLS: 14.4600
MUNICIPALITY: TYRONE TOWNSHIP
1",111",1"11,11",1,",11,111,1..11,,1,1.1.,11,,,"1,1,1"1.11
GOUSE, ARLENE E 12901
805 YELLOW HILL RD T81 P1
BIGLERVILLE, PA 17307-9489
1 ST OF 3 EQUAL
INSTALLMENTS DUE
08/31/07*
$13.20
OR FULL PAYMENT
BASE
09/01/07 TO
10/31/07
$39.62
2% DISCOUNT
07/1/07 TO
08/31/07
$38.83
10% PENALTY
11/01/07 TO
12/31/07
$43.58
t\.s~essment L~nd: $2,74C.OO
Assessment Buiiding: $.00
Assessment Total: $2,740.00
>AYMENT
)UE DATES
INST ALLM ENT
PAYMENT
::>PTION
~PPEALS
1UESTIONS
REAL ESTATE TAX INSTRUCTIONS - PLEASE READ
PLEASE NOTE THAT WEST PERRY SCHOOL DISTRICT REAL ESTATE TAXES ARE NO LONGER BEING COLLECTED BY
YOUR LOCAL TAX COLLECTOR. PAYMENTS MAY BE MADE AT ANY BANK OF LANDISBURG BRANCH (Blain,
Landisbur or Shermansdale OR MAY BE MAILED TO THE BANK.
All Real Estate tax bills have been mailed to the property owner. If your bank or mortgage company pays
your real estate taxes, you must forward this bill to them.
ALL CHECKS SHOULD BE MADE PAYABLE TO WEST PERRY SCHOOL DISTRICT.
IN PERSON - Payments may be made at any Bank of Landisburg branch office (Blain, Landisburg or Shermansdale)
Oriqinal, payment stub attached below must accompany payment
BY MAIL - Mail the oriqinal, micr-encoded payment stub attached below with your check (made payable to West Perry
School District) in the enclosed envelope. Make sure address shows through envelope window. U.S postmark will be
considered date paid. For receipt, enclose self-addressed, stamped envelope.
To pay 2% discount amount, make payment by 8/31107.
To pay base amount, make payment between 9/1/07 and 10/31/07.
To pay penalty amount, make payment between 11/1/07 and 12/31/07.
After 12/31/07, unpaid bills will be turned over to Perry County Delinquent Collections.
All property owners have the opportunity to make installment payments in three (3) equal installments on the base
amount You may pay the first payment as indicated above by 8/31/07; additional coupons will be mailed to you for
payments due 10/31 and 12/31/07. Payment of the 1st Installment Payment on or before the due date will indicate your
enrollment in the District's Installment Payment Plan. See insert for full terms and conditions of this payment plan
Questions regarding assessed value must be made to the Perry County AssessmentOffice (717) 582-2131. The school
district cannot make these changes. Appeal deadline is 9/1/07.
General questions regarding this tax bill, please call West Perry School
District at (717) 789-3934 ext. 5509 Monday-Friday 730AM to 330PM.
RETURN THIS STUB WITH PAYMENT I
Please indicate:
~ FULL PAYMENT
::J 1ST INSTALLMENT
2007/2008 REAL ESTATE TAX
JlAIL TO:
BILL NO. 003950 2700
TYRONE TOWNSHIP
270,178.02-042.000
KENNEDY VALLEY ROAD ..
o
W
N
E
R
GOUSE, ARLENE E
805 YELLOW HILL RD
BIGLERVILLE, PA 17307-9489
West Perry School District
c/o The Bank of Landisburg
P.O. Box 185
Landisburg, PA 17040-0185
1,""111..,111"""1.,111,,.11'1,",,111..1,.1,1,1,,1,"1"1"",111
FULL PAYMENT
1ST INSTALLMENT DUE DISCOUNT BASE PENALTY
8/31/07 07/01/07 - 08/31/07 09/01/07 -10/31107 11/01/07 - 12/31/07
R ~ 1~
$13.20 $38.83 $39.62 $43.58
11- 270000:l9 5011- I:O:l.:l. 2 . 2 :ll:
o b 9 9 2 j j 11-
855
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gouse, Arlene E.
FILE NUMBER
21-07-00060
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 American Funds Account No. 8154-1147-309: 82.493.00
2 Citizens Bank Account No. 6100745953: 5.709.74
3 Federal Income Tax Refund: 30.00
4 Members 1st FCU CD No. 109067-46: 7,087.43
5 Members 1st FCU CD No. 109067-47: 8,723.82
6 Members 1st FCU Savings Account: 25.66
7 1998 Ford Windstar Van: 1,500.00
TOTAL (Also enter on Line 5, Recapitulation)
105,569.65
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
William H. Wessels
Since 1986
811 Route 15 N, Dillsburg, PA 17019. Phone 432-2918. wesselsusedcars.com
Notary Public · Temporary Tags
<J.11-D-'
Ih I S IS 0--- \}J rl+\-~ VI C~~ prell S cJL
-f"D( +Yu- es--+c~Q of A (lLn( C10US~
Wt \J (A \ u{ -th'IS \ q q ~ Fa rd WI (]d~+C\ r
l(l\+1n '1Li) 000 m i If'S C\ + ~ \ Soo 00
S~t') u r~ ! Let- )
J eYVl {I\ M. WtS;;e)s
LJs~d lO-- ( IY\CLn (A ~' '
~I Citizens Bank
525 William Penn Place
Suite 153-2618
Pittsburgh, P A 15219
February 18,2007
S DAWN GLADFELTER
130 W CHURCH ST STE 100
DILLSBURG PA 17019
Estate of ARLENE E GOUSE
Date of Death: January 12,2007
SSN: 159-24-9482
Dear Madam:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of her date of death.
The decedent had 1 active account at the time of her death and she had no Safe Deposit Box.
For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 1-888-999-6884
Sincerely,
Phillip Lynch
Operations Services
~~ Citizens Bank
Account Number 6100745953
Account Title ARLENE E GaUSE
Date Opened 6/6/1966
Account Type Checking
Principal Balance as ofDOD $5,709.74
Interest from Last Posting to DOD $ .00
Account Balance as of DOD $5,709.74
YTD Interest to DaD $ .00
Capital Group
1/30/2007 8:32 AM PAGE
2/002
Fax Server
@ American Funds"
Ametk:an Funds Service Company
Post Office Box 2280
Norfolk. Virginia 23501-2280
americanfunds.com
DAWN GLADFELTER
THE WILEY GROUP
130 W CHURCH STREET SUITE 100
DILLSBURG PA 17019
January 30,2007
Re: The Cash Management Trust of America - C
Account #8154-1147-309
ARI"ENE E GOUSE
Dear Ms. Gladfelter:
We recently received an inquiry regarding the balance of account #8154-1147 -309.
The table below reflects the share balance, per share net asset value (NA V), and total value of the account on the
date requested:
Date
01112/07
Account Number
8154-1147-309
Share Balance
82,493.000
NA V Per Share
$1.00
Total Value
$82,493.00
Mutual fund share prices vary with the fluctuations of financial market share prices. The prices of the funds are
found in the [mancial pages of most metropolitan newspapers under American Funds in the Mutual Funds
listings.
The above mentioned account was established on August 22, 2006.
If you have any questions, please contact your financial adviser or call us at 800/421-0180. You can reach one
of our service representatives Monday through Friday between 8 a.m. and 8 p.m. Eastern time. You may also
obtain account information by visiting our website at www.americanfunds.com.
Cordially,
American Funds Service Company
REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Estate of: ARLENE E. GOUSE
Date of Death: January 12, 2007
Social Security Number: 159-24-9482
fvl~
MEMBERS 1st
FEDERAL CREDIT UNION
109067 -00
06/15/1989
$25.66
$.00
$25.66
None
109067 -46
05/15/2006
$7,080.60
$6.83
$7,087.43
None
109067-47
08/16/2006
$8,714.25
$9.57
$8,723.82
None
rr\MBERS 1ST FEDERAL CREDIT UNION
W\~LL A. lilt ~~
Danielle A. Kline
Insurance Services Specialist
March 14, 2007
5000 Louise Drive . PO. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1sLorg
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gouse, Arlene E.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07 -00060
ESTATE OF
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
12,958.73
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State Zip
2.
Attorney's Fees
Wiley, Lenox, Colgan, & Marzzacco, P.C.
7,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills:
306.00
5. Accountant's Fees
6.
Tax Return Preparer's Fees
Jones Accounting:
60.00
7.
Other Administrative Costs
See continuation schedule(s) attached
805.18
TOTAL (Also enter on line 9, Recapitulation)
21,629.91
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gouse, Arlene E.
FILE NUMBER
21-07 -00060
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Baughman Memorial Works, Inc.:
2.935.40
2
Cocklin Funeral Home:
10.023.33
Subtotal
12.958.73
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Li/ -ru 0Baughman Memorial Works, Inc.
f' DESIGNERS AND BUILDERS OF
e~M~
23-25 South Main Street
DOVER, PA. 17315
Telephone 292-2621
Total
Please design and build the following memorial
For .~.S;I;~~'I' '~'l; h~:""""""'" ............ ..........
Address. .80S .~. .~.'.... .l~. . .~~I~ -\. .fA. .\J.3.q!............
Des;gn No. .GBC".\.,s 1.1. ~ ~ . ~ '1. 0; ~,~. 'i2
Matedal~.",,\.~~ ~~ ~\J1'1<. JOD/lk.e.
Die \j
Price . . . . . . . . . . . . : Tax.. . . .
Deposit J.5m~..~.~.~f~o~~
Balance Due . .\.~~S'. ~l.q. ~\Ae.;--
Scv"l t.
\ 9 d l./ l6 J(k~ 2Y ~.
-t\\\~b
e
il r$q
I l'V L.DJ,' (\ ~
('<\l. rn 0 ('" f
-,
Base
Markers
.Y~ .)<. .\.4.
Pas ts
Family Name
Inscription .
A rLttvc E,
I~J 8' - Jm)
11. \ LI 6 ~
L--l4\\
.. .. .. .. e .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
XhOA~~. .~.......
Material to be best selected monwnental gr::'-:Q to be free from rmperfections and first class in every way. Work to
be ~~-:e:";~~~'::-:"H'" .'~~tI. tr.~rro.:.. H H' H . H H H fi~.. H H H ,H' H H H H Comotery
~i~~s n~~v~i~:;i1f' i~~~' 'b-~~bi~; '~d' '~th~;' ~~~:i;~~!~Y:dn~U:f ~~tr~~h~ .~ . ~~ibi~.' Addi:
tional lettering and other wbrlt on this memorial in the future is not included in the Contract Price.
Title and right of possession and removal of said stone, monument or appurtenances shall remain for all purposes in Baughman Memorial Works
until work and materials ordered are fully paid by purchaser or purchasers. In consideration of the acceptance by Baughman Memorial Works of this
order, the undersigned (hereinafter known as the purchaser) agrees to pay Baughman Memorial Works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ................... Dollars on or before the 15th day following
the billing of the work or job upon completion thereof by Baughman Memorial Works. Thirty (30) days from date of invoice a 1~% finance charge will
be added to the unpaid balance. Said billing to be notice of completion thereof, this order shall become a contract between the purchaser and Baugh-
man Memorial Works upon acceptance thereof in the space below by a duly authorized representative of said Baughman Memorial Works; it being
understood that this instrument upon such acceptance covers all of the agreement between the purchaser and Baughman Memorial Works and that
no agent or representative of Baughman Memorial Works has made any statements or agreements, verbal or written, modified or adding to the terms
and conditions herein set forth.
It is further understood that upon the acceptance of this order the contract so made cannot be cancelled, altered, or modified
by the purchaser or by any agent of Baughman Memorial Works or in any manner except by agreement in writing between the
purchaser and Baughman Memorial Works, and it is hereby understood and agreed by all parties involved that in case of de-
fault by purchaser or purchasers, twenty-five per cent of the total original cost of the work or work and materials ordered, as
the case may be, shall be a specified correct sum as liquidated damages which purchaser shall owe Baughman Memorial Works,
less any payment on account made prior to such default, this specification of damages to be due regardless of removal and
taking possession of stone, monument or materials from purchaser or purchasers by Baughman Memorial Works upon following
6uch default.
Style of Letters ............
Foundation to be furnished by
. . . . ... . . . .. . .. . ..... . ... . ... . . . ..... . ..... . \,\~<\). /................................................. ::::::
, ~))\i\} ~ )\' / \. _------____
Baughman Memorial Works Approval By .. .">.-1......... ~;.:..,.J..... .~.. ................... ... ..... .-::.... ......... .. .. .. (SEAL)
Wh;+o" nffiro rnnv' r...::ln~rv: r.1I40:tnrnpr rnnv' Pinlt-. ~1AC::rn2n (""nnv
"
4997
.';'"
,dO. ..~o
, ,-~
FEDERATED
.~:
uRIGINAL
ACCT NO.
?Yk"wdl-- ~ s. ffiL.~~
___---~.J L.l&'-~ ___~.! -~-~- -'"
.~..-t-~~-_._~~
,;"'//a~J
C;;;JrOI
Funeral Services
?:!l? pn<k"Nl ____..
Name of Oecea:;;eo
~CK#
o CREDIT
CARD
COCKLIN FUNERAL HOME, INC.
o OTHER
'h~~
c:31UIHk 6!lou/
9'o/....l
.~ I, dl)0J~
:1'),/ .
ORIGINAL
4997
ACCT. NO.
Ji~"''ffl!,"" ..... ~k1--. 5' L "i ~~
-------.------..---llJ t-I.__ ~ ~__
FU~;I Services C~~ [. y~~
'..}!?")f(/"I'I,('I ._~___~__.__ ~__ ___'.____,____._ _________ .________~__.
,L
do/Ian
Name of Deceased
CREDIT
COCKLIN FUNERAL HOME, rNc. I
b' {f-\.. 'il J~ I
.M'I -j- u.~ ~~~~ -.-1
.--jllln) ,..c!!frJI/
CARD
OTHER _____.____._
'laM tl~~.1L~CQ1-
LAST BALANCE _~_IQiQJ3_
LJ INfcRE:::>i
O LATE PAYMENT
~
SUB TOTAL
CREDITS
LESS PAYMENT
NEW BALANCE
LAST BALANCE
INTEREST
'---.J
\" LATE PAYMENT
i.J CHARGE
SUB TOTAL
CREDITS
LESS PAYMENT
NEW BALANCE $
.~ .., ,-....
! . ,..,.
~~-....- ~.
<6/t18~
$ \ ~ ) 4 I tJl
-,-J Jrj~
1 d ) c/ ti5
r,
-u-
. '.
Rev-1502 EX+ (6.98)
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gause, Arlene E.
FILE NUMBER
21-07 -00060
ESTATE OF
ITEM
NUMBER DESCRIPTION AMOUNT
1 Cumberland Law Journal (advertise estate): 75.00
2 Members 1st FCU (check charge): 9.95
3 Recorder of Deeds: 41.50
4 Register of Wills (additional short certificate): 4.00
5 Register of Wills (filing fee): 30.00
6 The Sentinel (advertise estate): 158.81
7 West Perry School District (school taxes): 485.92
Subtotal
805.18
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
. '.
Rev-1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gouse, Arlene E.
FILE NUMBER
21-07 -00060
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Caremark:
VALUE AT DATE
OF DEATH
10.00
2 Checks written prior to death, but not cleared as of the date of death letter from
Citizens Bank:
2.127.88
3 Continuing Care RX:
27.55
4 Cumberland Crossings:
2.597.16
5 Delores Kitner, Tax Collector (real estate taxes):
144.84
6 Embarq:
203.96
7 Hess Service Center:
67.31
8 Moblex:
66.04
9 National Finance Center:
127.15
10 Nationwide Insurance:
834.50
11 PA Department of Revenue:
97.00
12 PP&L:
90.01
TOTAL (Also enter on Line 10, Recapitulation)
6,393.40
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
,. .." .
REV 1513 EX+ (9-00)
*'
SCHEDULE .J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gause, Arlene E. 21-07 -00060
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trusteels)
I. TAXABLE DISTRIBUTIONS [include outright sProusal
aistributions, and ransfers
under Sec. 9116(a)(1.2)]
1 Linda 5. McCullough Daughter one hundred
805 Yellow Hill Road percent
Biglerville, PA 17307
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
Ian M. Wiley
David ). Lenox
Timothy). Colgan
Christopher ). Marzzacco
David E. Hershey
Thomas M. Clark
Angelica L. Rcvel,lllt
Paul ). Kovatch
THE WILEY GROUP
Attorneys at La"",
August 23,2007
Wiley, Lenox, Colgan & Marzzacco, P.c.
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
In Re: Estate of Arlene E. Gouse, deceased
File Number 21-07-00060
Dear Register:
Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status
report with regard to the above captioned estate. Also enclosed is a check in the amount of
$366.84 representing the tax due, and a check in the amount of $30.00 representing the filing fee.
Please return the recording receipts to my attention in the enclosed envelope.
Thank you for your cooperation.
Sincerely,
fbun
1".,-..
Dawn Gladfelter/Legal Ass'
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no W. Church Street, Suite 100 · Dillsburg, PA 17019 · Phone: (717) 432-9(166 · WOo) 6H2-4250 · Fax: (717) 4.32-0426
Offices in Harrisburg · York · Carbondale
www.wiley4u.com
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THE WILEY <-iR()IJP
At t< )f-neys at La'\.\t'
Wilev . [C!lOX
Colg,lIl . 1\;1'.11'1'7,]( CO . I'.c.
130 W. Church Street. Suite 100
Oillsburg, PA 17019
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UNITED WE STAND
Register of Wills
Cumberland County Courthous€
One Courthouse Square
Carlisle, P A 17013